title: Long-term incidence and prognostic factors of the progression of new coronary lesions in Japanese coronary artery disease patients after percutaneous coronary intervention.
abstract: Revascularization of an initially non-target site due to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease (CAD) in the era of drug-eluting stents. Using the Shinken database, a single-hospital-based cohort, we aimed to clarify the incidence and prognostic factors for progression of previously non-significant coronary portions after prior percutaneous coronary intervention (PCI) in Japanese CAD patients. We selected from the Shinken database a single-hospital-based cohort of Japanese patients (n = 15227) who visited the Cardiovascular Institute between 2004 and 2010 to undergo PCI. This study included 1,214 patients (median follow-up period, 1,032 ± 704 days). Additional clinically driven PCI to treat previously non-significant lesions was performed in 152 patients. The cumulative rate of new-lesion PCI was 9.5 % at 1 year, 14.4 % at 3 years, and 17.6 % at 5 years. There was no difference in background clinical characteristics between patients with and without additional PCI. Prevalence of multi-vessel disease (MVD) (82 vs. 57 %, p < 0.001) and obesity (47 vs. 38 %, p = 0.028) were significantly higher and high-density lipoprotein cholesterol (HDL) level (51 ± 15 vs. 47 ± 12 mg/dl, p < 0.001) was significantly lower in patients with additional PCI than those without. Patients using insulin (6 vs. 3 %, p = 0.035) were more common in patients with additional PCI. Multivariate analysis showed that MVD, lower HDL, and insulin use were independent determinants of progression of new culprit coronary lesions. In conclusion, progression of new coronary lesions was common and new-lesion PCI continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years. Greater coronary artery disease burden, low HDL, and insulin-dependent DM were independent predictors of progression of new culprit coronary lesions.
authors.affiliation: The Department of Cardiovascular Medicine, The Cardiovascular Institute, 3-2-19 Nishiazabu, Minato-ku, Tokyo, 106-0031, Japan, h-kaneko@cvi.or.jp.
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Kaneko
authors.forename: Junji
authors.initials: J
authors.lastname: Yajima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Shingo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Daisuke
authors.initials: D
authors.lastname: Fukamachi
authors.forename: Shinya
authors.initials: S
authors.lastname: Suzuki
authors.forename: Koichi
authors.initials: K
authors.lastname: Sagara
authors.forename: Takayuki
authors.initials: T
authors.lastname: Otsuka
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Matsuno
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kano
authors.forename: Tokuhisa
authors.initials: T
authors.lastname: Uejima
authors.forename: Akira
authors.initials: A
authors.lastname: Koike
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagashima
authors.forename: Hajime
authors.initials: H
authors.lastname: Kirigaya
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sawada
authors.forename: Tadanori
authors.initials: T
authors.lastname: Aizawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000368:Aged; D044466:Asian People; D016009:Chi-Square Distribution; D008076:Cholesterol, HDL / Q000097:blood; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology; D018450:Disease Progression; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000208:ethnology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D007004:Hypoglycemic Agents; D007328:Insulin